Provider Demographics
NPI:1710936166
Name:PALMER, ROLF GUSTAV (MD)
Entity Type:Individual
Prefix:
First Name:ROLF
Middle Name:GUSTAV
Last Name:PALMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 96
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-0096
Mailing Address - Country:US
Mailing Address - Phone:925-933-3902
Mailing Address - Fax:925-933-3902
Practice Address - Street 1:1120 2ND ST
Practice Address - Street 2:SUITE109
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-2295
Practice Address - Country:US
Practice Address - Phone:925-933-3902
Practice Address - Fax:925-933-3902
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA399992084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A399990Medicare ID - Type Unspecified
A29017Medicare UPIN